Cumulative Effective Dose During Fluoroscopically Guided Interventions (FGI): Analysis of More Than 5000 FGIs in a Single European Center.

Abstract

The number of fluoroscopically guided interventions (FGI) has increased significantly over time. However, little attention has been paid to possible stochastic radiation effects. The aim of thisretrospective study was to investigatethe number of patients who received cumulative effective dosesover 100mSvduring FGI procedures. Five thousand five hundred and fifty four classified FGI procedures were included. Radiation dose data, retrieved from an in-house-dose-management system, was analysed. Effective doses and cumulative effective doses (CED) were calculated. Patients who received a CED > 100mSv were identified. Radiology reports, patient age, imaging and clinical data of these patients were used to identify reasons for CED ≥ 100mSv. One Hundred and thirty two (41.1% female) of 3981 patients received a CED > 100 mSy, with a mean CED of 173.5 ± 84.5mSv. Mean age at first intervention was 66.1 ± 11.7years. 81 (61.4%) of 132 were older than 64years, one patient was < 30years. 110 patients received ≥ 100mSv within one year (83.4%), through FGIs: EVAR, pelvic/mesenteric interventions (stent or embolization), hepatic interventions (chemoembolization, TIPSS), embolization of cerebral aneurysms or arterio-venous-malformations. Substantial CED may occur in a small but not ignorable fraction of patients (~ 3%) undergoing FGIs. Approximately 2/3rd of patients may most likely not encounter radiation-related stochastic effects due to life-threatening diseases and age at first treatment > 65years but 1/3rd may. Patients undergoing more than one FGI (77%) carry a higher risk of accumulating effective doses > 100mSv. Remarkably, 23% received a mean CED 162.2 ± 72.3mSv in a single procedure.